Decolonizing public health by addressing power and the architecture of global knowledge production

This commentary interrogates the evolving concepts of colonialism, postcolonialism, and decolonization through the critical lens of global health systems, medical education, and clinical practice. It argues that modern medicine emerged alongside colonial capitalism and European scientific rationality, producing enduring hierarchies that continue to position Western knowledge as universal while marginalizing expertise from the Global South. Drawing from postcolonial and decolonial theorists including Frantz Fanon, Walter Mignolo, Eve Tuck, K. Wayne Yang, and Teju Cole, the paper examines how coloniality persists through epistemic injustice, asymmetrical knowledge production, funding inequities, authorship hierarchies, and the white savior industrial complex. Using historical examples from Uganda and Tanzania alongside contemporary critiques of North–South research partnerships, the analysis demonstrates how medicine and public health have functioned not only as systems of care but also as technologies of governance, surveillance, and social control. The commentary explores Fanon’s concept of sociogenesis and the “zone of non-being,” Mignolo’s call for epistemic disobedience and pluriversality, and Tuck and Yang’s warning that decolonization must not become a metaphor detached from material redistribution and Indigenous sovereignty. It further critiques the “foreign gaze” in global health research, where scholars from low- and middle-income countries often write for Western validation rather than local transformation. At the same time, the paper highlights emerging pathways toward reciprocal and ethically grounded collaboration through Global Health Reciprocal Innovation (GHRI), frugal innovation, cultural safety, and co-produced knowledge systems. Examples such as Brazil’s Community Health Worker model and low-cost surgical technologies illustrate how innovation can flow multidirectionally rather than unilaterally from North to South. This commentary contributes to ongoing decolonial debates by moving beyond a critique of colonial legacies to synthesize practical pathways for transforming health systems. Drawing together insights from postcolonial theory, decolonial thought, reciprocal innovation, cultural safety, and health governance, it proposes an integrative framework for understanding how coloniality operates simultaneously across knowledge production, clinical practice, research partnerships, and institutional decision-making. By connecting these domains, the commentary frames decolonization not merely as a theoretical critique but as a multidimensional agenda for restructuring authority, accountability, and knowledge within contemporary health systems.